# SHAWNEE DENTAL, PLLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780878108
- **Authorized official:** THOMAS E MCLEAN D.M.D. (OWNER)
- **Authorized official phone:** (502) 774-2400

## Contact information

- **Practice address:** 222 AMY AVE, LOUISVILLE, KY 40212-2522
- **Practice address phone:** (502) 774-2400
- **Practice address fax:** (502) 772-3456
- **Mailing address:** 222 AMY AVE, LOUISVILLE, KY 40212-2522
- **Mailing address phone:** (502) 774-2400
- **Mailing address fax:** (502) 772-3456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/29/2007
- **Last updated:** 08/29/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 61901344 | — | KY |